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Nuklearmedizin 1995; 34(06): 215-222
DOI: 10.1055/s-0038-1629717
Original Article
Schattauer GmbH

Separation of Autonomous Function from Cell Density in Non-Immunogenic Hyperthyroidism[*]

I. Quantification by Double-Isotope Parametric Scintigraphy
Claudine Als
1   From the Dept. of Nuclear Medicine, University of Berne, Inselspital Berne, Switzerland
,
Maria Listevnik
1   From the Dept. of Nuclear Medicine, University of Berne, Inselspital Berne, Switzerland
,
H. Rösier
1   From the Dept. of Nuclear Medicine, University of Berne, Inselspital Berne, Switzerland
,
E.-P. Ritter
1   From the Dept. of Nuclear Medicine, University of Berne, Inselspital Berne, Switzerland
› Author Affiliations
Further Information

Publication History

Received: 25 February 1995

in revised form: 28 June 1995

Publication Date:
05 February 2018 (online)

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Summary

A new quantitative subtraction method of thyroid scans is proposed which shows that regional function (F) by far exceeds regional cellularity or cell density (C) in potentially toxic thyroidal areas of non-immunogenic hyperthyroidism (NIH). Methods: A multistep processing of radioiodine and MIBI thyroid scans of patients with non-immunogenic hyperthyroidism led to normalized images of regional function excess and of perinodular enhancement. Two numeric factors were derived from regions of interest: Q (cell density ratio) comparing MIBI uptake in autonomous and suppressed areas and T (toxicity index): the maximal F/C contrast. Results: Q never exceeded 61; T, however, expanded toxicity levels over a range of 6-8735 with toxic adenomas (median = 165) and with hot areas of multifocal functional autonomy (median = 15). T was weakly correlated to serum TT3 (r = 0.41), but not to autonomous tissue mass, ultrasonographic or cytologic criteria. Conclusions: T is governed by inherent features of autonomous tissue and the response of the imbedded thyroid tissue to TSH stimulation. This standardized technique consolidates experiences from visual analysis; the huge T range mirrors the natural evolution from compensated autonomy towards hyperthyroid, decompensated stages.

Zusammenfassung

Anhand einer neuen quantitativen Subtraktions-Methode von Schilddrüsen-Szintigrammen wird gezeigt, daß die regionale Exzeß-Funktion (F) die begleitende zunehmende Zellularität und Zelldichte (C) in potentiell toxischen Arealen der nichtimmunogenen Hyperthyreose (NIH) erheblich übersteigt. Methode: Von Radiojod- und MIBI-Szintigrammen der Schilddrüse bei Patienten mit NIH werden am Computer normalisierte Verteilungsbilder des regionalen Zell- und Funktions-Exzesses und der perinodulären Hervorhebung erhalten. Zwei numerische Faktoren werden aus ROIs abgeleitet: Q (Zelldichte-Quotient) vergleicht die MI BiAufnahme in autonomen und supprimierten Arealen, und T (Toxizitäts-Index): der maximale F/C-Kontrast. Ergebnisse: Für Q wurde 61 als höchster Wert erhalten; T dagegen erfaßt Toxizitätsgrade zwischen 6 und 8735 bei toxischen Adenomen (median = 165) und heißen Arealen der multifokalen Autonomien (median = 15). T ist schwach korreliert zum Serum-TT3 (r = 0.41), nicht aber zur Masse des autonomen Gewebes oder zu Befunden aus Ultrasonographie und Zytopatholo-gie. Schlußfolgerung: Das Ausmaß von T wird bestimmt durch die besonderen Eigenschaften des autonomen Gewebes und die TSH-Reaktion der umgebenden Schilddrüse. Die standardisierte Technik bestätigt Erfahrungen aus visueller Analyse; der breite Bereich für T umfaßt die natürliche Entwicklung von kompensierten zu hyperthyreoten, dekompensierten Stadien der Autonomie.

Keywords

Non-immunogenic hyperthyroidism - cell density - autonomous function - double-isotope scintigraphy - 99mTc-Hexamibi

Schlüsselwörter

Nichtimmunogene Hyperthyreose - Zelldichte - autonome Funktion - Doppeltra-cerszintigraphie - 99mTc-Hexamibi

* This manuscript, along with its second part (Ref. 3) has been awarded the ‘Jubilee Prize 1995 of the Swiss Society of Medical Radiology’ on the occasion of ‘100 years of X rays’


 

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